Multi-functional surgical device for neurosurgical and spinal surgery applications

ABSTRACT

A tissue cutting device that is especially suited for neurosurgical applications is disclosed and described. The device includes a handpiece and an outer cannula in which a reciprocating inner cannula is disposed. The device is configured to provide multiple functions during a surgical procedure, in addition to resecting tissue, with a single insertion of the device into a patient.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. application Ser. No. 12/435,724, filed on May 5, 2009, which is a continuation-in-part of U.S. application Ser. No. 12/404,407, filed on Mar. 16, 2009, which is a continuation-in-part of U.S. application Ser. No. 12/391,579, filed on Feb. 24, 2009, which is a continuation-in-part of U.S. application Ser. No. 12/389,447, filed on Feb. 20, 2009, which is a continuation-in-part of U.S. application Ser. No. 12/336,054, filed Dec. 16, 2008 and U.S. application Ser. No. 12/336,086, filed Dec. 16, 2008, each of which is hereby incorporated by reference in its entirety.

TECHNICAL FIELD

The present disclosure relates to surgical devices, in particular, surgical devices that perform multiple functions and that are suited for neurosurgical and spinal surgical procedures.

BACKGROUND

Various abnormalities of the neurological system, such as brain and spinal tumors, cysts, lesions, or neural hematomas, can cause severe health risks to patients afflicted by them, including deterioration in motor skills, nausea or vomiting, memory or communication problems, behavioral changes, headaches, or seizures. In certain cases, resection of abnormal tissue masses is required. However, given the complexity and importance of the neurological system, such neurosurgical procedures are extremely delicate and must be executed with great precision and care. Certain known surgical devices include tissue cutting devices that reciprocate an inner cutting cannula within an outer cannula and aspirate severed tissue samples along the inner cannula lumen. However, many such devices can perform a single or at best two functions with a single insertion. For example, some prior art devices are configured to sever and aspirate tissue. Additionally, such prior art devices are configured with a straight outer cannula and are unsuitable for accessing difficult to reach tissue. Moreover, oftentimes, it would be beneficial to move or manipulate critical structures during a procedure. However, traditionally, such steps during a procedure require removal of the tissue cutting device, insertion of a second surgical instrument and then reintroduction of the tissue cutting device. Such steps undesirably decrease the efficiency of the procedure, increase the length of a procedure, and increase the fatigue of the surgeon which decreases the surgeons ability to stay focused on the critical structures while managing these critical structures during the surgical procedure thereby increasing the risk of the procedure. Additionally, neurosurgical and spinal surgical procedures continue to move towards smaller surgical accesses which have created less invasive procedures for patients. These minimally invasive procedures create challenges for the clinician as the surgical corridors that can be created are deeper in the body and are often created adjacent to or even through critical biological complexes of the body such as vessels, nerves, nerve bundles and healthy tissues. Thus, a need has arisen for a multi-functional device that perform a variety of tasks while maintaining a low profile in a minimally invasive surgical procedure to reduce the number of surgical instruments and without requiring the frequent exchange of multiple instruments within the surgical field of a surgical procedure.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments of the present disclosure will now be described by way of example in greater detail with reference to the attached figures, in which:

FIG. 1 is a perspective view of a tissue cutting device in accordance with a first embodiment;

FIG. 2 is a cross-sectional view of the tissue cutting device of FIG. 1 depicting an inner cannula in a first relative position with respect to an outer cannula in which the inner cannula's distal end is located proximally of the outer cannula's distal end;

FIG. 3 is a cross-sectional view of the tissue cutting device of FIG. 1 depicting the inner cannula in a second relative position with respect to the outer cannula in which the inner cannula's distal end is located at the distal end of the outer cannula;

FIG. 4 is a partial cross-sectional view of the tissue cutting device of FIG. 1 in a first configuration in which a device-mounted tissue collector is disconnected from a tissue cutting device housing;

FIG. 5 is a partial cross-sectional view of the tissue cutting device of FIG. 4 in a second configuration in which the device-mounted tissue collector is connected to the tissue cutting device housing;

FIG. 6 is a partial cross-sectional view of an alternate embodiment of the tissue cutting device of FIG. 1 in a first configuration in which the device-mounted collector is disconnected from the tissue cutting device;

FIG. 7 is partial cross-sectional view of the tissue cutting device of FIG. 6 in a second configuration in which the device-mounted tissue collector is connected to the tissue cutting device;

FIG. 8 is a broken side elevation view of the outer cannula of the tissue cutting device of FIG. 1;

FIG. 9 is a broken side elevation view of the inner cannula of the tissue cutting device of FIG. 1;

FIG. 10 is a top plan view of a portion of the outer cannula of the tissue cutting device of FIG. 1 with the inner cannula removed from the outer cannula;

FIG. 11 is a top plan view of a portion of the inner cannula of the tissue cutting device of FIG. 1;

FIG. 12 is a top plan view of a portion of the outer cannula and inner cannula of FIG. 1 depicting the inner cannula inserted into the outer cannula;

FIG. 13 is a partial cross-sectional view of a distal region of the outer cannula and the inner cannula of the tissue cutting device of FIG. 1, depicting the inner cannula in a first relative position with respect to the outer cannula;

FIG. 14 is a partial cross-sectional view of a distal region of the outer cannula and the inner cannula of the tissue cutting device of FIG. 1, depicting the inner cannula in a second relative position with respect to the outer cannula;

FIG. 15 is an exploded assembly view of the tissue cutting device of FIG. 1;

FIG. 16a is a side elevation view of a cam of the tissue cutting device of FIG. 1;

FIG. 16b is an end elevation view of the cam of FIG. 16 a;

FIG. 17a is a perspective view of a cam transfer mechanism of the tissue cutting device of FIG. 1;

FIG. 17b is a perspective view of a cam follower of the tissue cutting device of FIG. 1;

FIG. 18 is a partial perspective view of a portion of the tissue cutting device of FIG. 1 with an upper shell of an outer sleeve upper housing removed to show a dial for rotating an outer cannula;

FIG. 19 is a partial side cross-sectional view of the portion of the tissue cutting device of FIG. 18;

FIG. 20 is a side elevation view of an inner and outer cannula assembly of the tissue cutting device of FIG. 1;

FIG. 21A is a tissue cutting system including a remote tissue collector, control console, foot pedal, and the tissue cutting device of FIG. 1;

FIG. 21B is an enlarged view of the remote tissue collector of FIG. 21A;

FIG. 22 is a block diagram of a control scheme for the tissue cutting system of FIG. 22;

FIG. 23 is diagram of the tissue cutting device of FIG. 1 and the motor control unit of FIG. 22;

FIG. 24 is a partial cross-sectional view of the tissue cutting device of FIG. 1 depicting motor shaft position sensors for controlling a stop position of an inner cannula;

FIG. 25 is a partial cross-sectional view of the outer cannula and inner cannula of the tissue cutting device of FIG. 1 with the inner cannula in a first position relative to the outer cannula;

FIG. 26 is a partial cross-sectional view of the outer cannula and inner cannula of the tissue cutting device of FIG. 1 with the inner cannula in a second position relative to the outer cannula;

FIG. 27 is a partial cross-sectional view of the outer cannula and the inner cannula of the tissue cutting device of FIG. 1 with the inner cannula in a third position relative to the outer cannula;

FIG. 28 is a top plan view of an alternate embodiment of an inner cannula which includes a bending portion;

FIG. 29 is a side elevational view of the inner cannula of FIG. 28;

FIG. 30a is a close-up sectional view of the proximal end of the bending portion of the inner cannula of FIG. 28;

FIG. 30b is a close-up sectional view of the distal end of the bending portion of the inner cannula of FIG. 28;

FIG. 31 is a cross-sectional view taken across line 31-31 in FIG. 28;

FIG. 32 is a perspective view of a tube bender;

FIG. 33 is a side elevational view of a tube bender;

FIG. 34 is a rear elevational view of a tube bender;

FIG. 35 is a side elevational view of a tissue cutting device in a first position during a tube bending operation;

FIG. 36 is a side elevational view of a tissue cutting device in a second position during a tube bending operation;

FIG. 37A is a diagram illustrating the use of a tissue cutting device with an inner cannula that includes a bending portion and a curved outer cannula;

FIG. 37B is a close-up view of a portion of FIG. 37A;

FIG. 38 is a side plan view of an alternate embodiment of an inner cannula with a bending portion;

FIG. 39 is a close-up view of a distal portion of the inner cannula of FIG. 38;

FIG. 40 is a cross-sectional view taken along the line 40-40 in FIG. 38; and

FIG. 41 is a cross-sectional view taken along the line 41-41 in FIG. 39.

DETAILED DESCRIPTION

Referring now to the discussion that follows and also to the drawings, illustrative approaches to the disclosed systems and methods are shown in detail. Although the drawings represent some possible approaches, the drawings are not necessarily to scale and certain features may be exaggerated, removed, or partially sectioned to better illustrate and explain the present disclosure. Further, the descriptions set forth herein are not intended to be exhaustive or otherwise limit or restrict the claims to the precise forms and configurations shown in the drawings and disclosed in the following detailed description.

Described herein are tissue cutting devices that are suited for neurosurgical applications such as the removal of spine and brain tissue. The devices are configured with a semi-solid seal at one end of an annular space between an inner reciprocating cannula and an outer cannula. As a result, the tissue cutting devices of the present disclosure avoid the generation of air artifacts and fluid flow within the annular space, thereby facilitating the use of relatively higher inner cannula reciprocation rates than are found in many known devices. In certain embodiments, the tissue cutting device is provided with an inner cannula stop position control that can be used to bring the inner cannula to rest at a position selected by the user. In particular, the user can set the stop position to a location within the outer cannula tissue receiving opening and use the device as an aspiration wand. In certain other embodiments, a selectively curvable inner cannula is provided for use with a curved outer cannula to facilitate the resection of target tissues that cannot be accessed along a linear path.

Referring to FIG. 1, a tissue cutting device 40 includes a handpiece 42 and an outer cannula 44. In one exemplary embodiment, handpiece 42 is generally cylindrical in shape and is preferably sized and shaped to be grasped with a single hand. Handpiece 42 includes a lower housing 50 which comprises a proximal section 46 and distal section 48. Lower housing 50 comprises a proximal-most housing portion 82 (FIGS. 2 and 3) that is connected to a motor housing 71, and a cam housing 69 that is connected to motor housing 71. A front housing section 51 is connected to cam housing 69. Upper housing 52 is also provided. A tissue collector 58 may be operatively connected to upper housing 52 (as will be explained in further detail below). A rotation dial 60 for rotating the outer cannula 44 with respect to handpiece 50 is also mounted to upper housing 52.

As best seen in FIGS. 2, 3, and 20, outer cannula 44 includes an open proximal end 45, a closed distal end 47, and a distal opening 49 proximate distal end 47. Tissue cutting device 40 further comprises an inner cannula 76 which is partially disposed in an outer cannula lumen 110. Inner cannula 76 is configured to reciprocate within outer cannula lumen 110 and to cut tissue samples entering outer cannula 44 via outer cannula distal opening 49, as will be described in greater detail below. Inner cannula 76 reciprocates between a proximal position, which is depicted in FIG. 2 and a distal position which is depicted in FIG. 3. Inner cannula 76 includes an open proximal end 77 and an open distal end 79. Distal end 79 is preferably configured to cut tissue, and in preferred embodiments is capable of cutting neurological system tissues such as those from the brain or spine. In one exemplary embodiment, inner cannula distal end 79 is beveled in a radially inward direction to create a sharp circular tip and facilitate tissue cutting.

Outer cannula 44 is not translatable, and its position with respect to handpiece 42 along the direction of the longitudinal axis of handpiece 42 remains fixed. Motor 62 is disposed in proximal lower housing section 46 of handpiece 42 and is operably connected to inner cannula 76 to drive the reciprocation of inner cannula 76 within outer cannula lumen 110. Motor 62 may be a reciprocating or rotary motor. In addition, it may be electric or hydraulic. However, in the embodiment of FIGS. 2 and 3, motor 62 is a rotary motor, the rotation of which causes inner cannula 76 to reciprocate within outer cannula lumen 110.

Motor 62 is housed in motor housing 71, which defines a portion of lower housing proximal section 46. Motor 62 is connected to an inner cannula drive assembly 63 which is used to convert the rotational motion of motor 62 into the translational motion of inner cannula 76. At its proximal end, motor housing 71 is connected to proximal-most housing portion 82, which includes a power cable port 84 and a hose connector 43, which in the exemplary embodiment of FIG. 3 is an eyelet. Hose connector 43 provides a means of securely retaining a vacuum system hose to handpiece 42, thereby allowing vacuum to be supplied to tissue collector 58.

Inner cannula driver assembly 63 (not separately shown in figures) comprises a cam 64, a cam follower 68, a cam transfer 72, and a cannula transfer 74. Cam 64 is a generally cylindrical structure and is shown in detail in FIGS. 16A and 16B. A groove or channel 65 is defined in the surface of cam 64. In one exemplary embodiment, groove 65 is continuous and circumscribes the perimeter of cam 64 but is not oriented perpendicularly to the longitudinal axis of cam 64, i.e., groove 65 is angled with respect to the cam axis. Opposing points on groove 65 such as points 65 a and 65 b define pairs of “apexes” that are spaced apart along the longitudinal axis of the cam, i.e., the groove extends along a portion of the length of the cam. Cam 64 also includes a proximal opening 114 (FIG. 16a ) for receiving a motor shaft and a proximal recess 116 into which a shaft may be snugly received. Holes 118 and 120 are provided for mounting position indicators that cooperate with a position sensor to determine the angular position of cam 64, and correspondingly, the linear position of inner cannula 76 within the outer cannula lumen 110, as discussed below.

Cam follower 68 is depicted in detail in FIG. 17B. Cam follower 68 is a generally rectangular block shaped structure with a hollow interior in which cam 64 is partially disposed. Cam follower 68 also includes a hole 70 in its upper face in which a ball bearing (not shown) is seated. The ball bearing rides in cam groove 65 and engages cam transfer 72. As a result, when cam 64 rotates, cam follower 68 translates along the length of handpiece 42. Cam follower 68 also includes lateral slots 182 a and 182 b that cooperatively engage corresponding members 178 a, 178 b from cam transfer 72.

Cam follower 68 is disposed within a cam chamber 67 formed in cam housing 69. Cam 64 is partially disposed in cam chamber 67 and extends proximally therefrom to engage motor 62. Cam housing 69 comprises part of distal portion 48 of handpiece 42. Cam 64 does not reciprocate within cam chamber 67 and instead merely rotates about its own longitudinal axis. However, cam follower 68 reciprocates within cam chamber 67 along the direction of the length of handpiece 42. Cam follower 68 is open at its proximal end to receive cam 64. As shown in FIGS. 15 and 16A, cam 64 may optionally include a threaded distal end 123 that projects through a distal opening 191 (FIG. 17b ) in cam follower 68 and which engages a nut 190 (FIG. 15) to prevent reciprocation of cam 64 relative to cam housing 69. Proximal cam bearing 186 and distal cam bearing 188 (FIG. 15) may also be provided to support cam 64 as it rotates within cam housing 69.

Cam transfer 72 extends from cam chamber 67 into a cam transfer chamber 73 formed in upper housing 52. As best seen in FIG. 17a , cam transfer 72 comprises a proximal end 72 a that is attachable to cam follower 68 and a distal end 72 b that is attachable to inner cannula 76 via cannula transfer 74. Proximal end 72 a comprises a pair of spaced apart, downwardly extending members 178 a and 178 b, and distal end 72 b comprises a pair of spaced apart upwardly extending members 180 a and 180 b. Downwardly extending members 178 a and 178 b are spaced apart in a direction that is perpendicular to the length of cam 64 and handpiece 42, while upwardly extending members 180 a and 180 b are spaced apart in a direction that is parallel to the length of cam 64 and handpiece 42. Cam follower slots 182 a and 182 b engage downwardly extending members 178 a and 178 b of cam transfer 72. Downwardly extending members 178 a and 178 b of cam transfer 72 may be resilient and may have engagement portions 179 a and 179 b on their free ends (e.g., hooks or clips) for securely engaging the bottom and side surfaces of cam follower 68.

As best seen in FIG. 20, cannula transfer 74 comprises a sleeve disposed about inner cannula 76. Cannula transfer 74 comprises a proximal end 128, middle section 127, and distal end 126. Upwardly extending members 180 a and 180 b of cam transfer 72 define fork-shaped structures that receive and cradle middle section 127 of cannula transfer 74. Distal end 126 and proximal end 128 of cannula transfer 74 are disposed outwardly of upwardly extending members 180 a and 180 b and are shaped to prevent relative translation between cam transfer 72 and cannula transfer 74. In the depicted embodiments, distal end 126 and proximal end 128 of cannula transfer 74 are enlarged relative to middle section 127 to abut the upwardly extending, fork-shaped members 182 a and 182 b, thereby preventing relative translation between cam transfer 72 and cannula transfer 74. As a result, when cam transfer 72 reciprocates along the length of handpiece 42, cannula transfer 74 reciprocates as well. Because it is affixed to inner cannula 76, when cannula transfer 74 reciprocates, it causes inner cannula 76 to reciprocate within outer cannula 44.

In one exemplary arrangement, motor 62 is a brushed DC motor and may be operably connected to cam 64 in a number of ways. In the embodiment of FIGS. 2 and 3, motor 62 includes a distally extending shaft 66 that extends into a proximal opening 114 and engages recess 116 defined in cam 64. Shaft 66 may be connected to cam 64 via a threaded connection, adhesive, or other known connection means. In an alternate implementation, depicted in FIG. 15, a separate cam coupler 184 is provided. Cam coupler 184 is seated in proximal opening 114 and has a width greater than the diameter of opening 114. Cam coupler 184 is also connected to motor shaft 66 such that rotation of shaft 66 causes cam coupler 184 to rotate, which in turn causes cam 64 to rotate therewith. One revolution of motor shaft 66 causes cam 64 to rotate by one revolution, which in turn causes inner cannula 76 to reciprocate by one complete stroke, i.e., from the position of FIG. 2 to the position of FIG. 3 and back to the position of FIG. 2.

Cam transfer 72 may be connected to cam follower 68 by mechanical means, adhesive means or other known connection means. In one exemplary embodiment, downwardly extending members 178 a and 178 b mechanically clip onto and removably engage cam follower 68. In another embodiment, cam transfer 72 is adhesively affixed to cam follower 68. In yet another embodiment, both mechanical and adhesive connections are used. The ball bearing (not shown) disposed in cam follower hole 70 traverses cam groove 65 as cam 64 rotates, causing cam follower 72 to reciprocate from the proximal position of FIG. 2 to the distal position of FIG. 3. As a result, cam transfer 72, cannula transfer 74 and inner cannula 76 translate between their respective proximal positions of FIG. 2 and their respective distal positions of FIG. 3 when motor 62 and cam 64 rotate.

Motor 62 is preferably selected to have a rotational speed that allows inner cannula 76 to reciprocate from the position of FIG. 2 to the position of FIG. 3 and back to the position of FIG. 2 at a rate of at least about 1,000 reciprocations/minute. Reciprocation rates of at least about 1,200 reciprocations/minute are more preferred, and reciprocation rates of at least about 1,500 reciprocations/minute are even more preferred. Reciprocation rates of less than about 2,500 reciprocations/minute are preferred. Reciprocation rates of less than about 2,000 are more preferred, and reciprocation rates of less than about 1,800 reciprocations/minute are even more preferred. As best seen in FIG. 14, the rates of reciprocation of device 40 allow tissue to be severed into “snippets” 112 which are relatively smaller than “slug” tissue samples obtained by many prior devices. As the reciprocation continues, a continuum of severed tissue snippets 112 is obtained.

As mentioned previously, outer cannula 44 includes an opening 49 for receiving tissue into outer cannula lumen 110. As best seen in FIGS. 8-12, opening 49 is preferably defined by a cutting edge 51 that is configured to sever tissue and a non-cutting edge 53 that is not configured to sever tissue. In certain exemplary implementations, cutting edge 53 has a radial depth “d” that is no greater than about 50% of the outer diameter of outer cannula 44. In one exemplary implementation, cutting edge 51 is beveled in a radially inward direction, non-cutting edge 53 is not beveled, and cutting edge 51 is located immediately distally of non-cutting edge 53. Inner cannula distal end 79 is preferably configured to cut tissue. In one exemplary embodiment, distal end 79 is beveled in a radially inward direction around the circumference of inner cannula 76 to provide a sharp edge. As tissue is received in outer cannula opening 49, it is compressed between inner cannula distal end 79 and, outer cannula cutting edge 51, causing the received tissue to be severed from the surrounding tissue.

Tissue cutting device 40 is particularly well suited for use in cutting tough tissues such as spinal and brain tissues. Outer cannula 44 and inner cannula 76 comprise materials that are generally rigid, such as rigid plastics or metal. In one preferred implementation, both cannulae comprise stainless steel, and more preferably, 304SS typically used in medical grade instruments.

As best seen in FIGS. 9-14, to facilitate the cutting of tough tissues, inner cannula 76 includes a hinge 80. Hinge 80 is located between inner cannula body section 81 which is located on the proximal side of hinge 80 and inner cannula cutting section 83 which is located on the distal side of hinge 80. In one exemplary arrangement, hinge 80 is a living hinge. As used herein, the term “living hinge” refers to a thin, flexible hinge that joins two relatively more rigid parts together. In one example, hinge 80 is a living hinge that is integrally formed with inner cannula body section 81 and inner cannula section 83 by removing a portion of the circumference of the inner cannula 76 along a length L (FIG. 11). Hinge 80 allows cutting section 83 to pivot about hinge 80 as inner cannula 76 reciprocates within outer cannula 44. As inner cannula 76 translates in the distal direction, it contacts tissue received in outer cannula opening 49 and encounters progressively increasing resistance from the tissue as the tissue is urged in the distal direction. As the resisting force of the tissue increases, cutting section 83 pivots progressively more until a zero annular clearance is obtained between inner cannula distal end 79 and outer cannula opening 49. The received tissue is severed and aspirated in the proximal direction along inner cannula lumen 110 and received in tissue collector 58. Thus, inner cannula lumen 110 provides an aspiration path from the inner cannula distal end 79 to the inner cannula proximal end 77. Hinge 80 allows a generally zero annular clearance to be obtained between inner cannula distal end 79 and outer cannula opening 49 at cutting section 80 while not affecting the annular clearance between inner cannula body section 81 and outer cannula 44. This configuration maximizes tissue cutting while minimizing frictional losses that would otherwise occur due to the frictional engagement of the outer surface of inner cannula body section 81 and the inner surface of outer cannula 44 if a very small annular clearance between the outer cannula 44 and inner cannula 76 were present.

Outer cannula opening 49 may have a number of shapes. In certain examples, when outer cannula opening 49 is viewed in plan, it has a shape that is generally square, rectangular, trapezoidal, ovular, or in the shape of the letter “D.” In certain other exemplary implementations, outer cannula opening 49 is configured to direct tissue so that it may be compressed as inner cannula 76 translates in the distal direction. In one exemplary embodiment, depicted in FIGS. 10 and 12, outer cannula opening 49 has a generally triangular shape when outer cannula opening 49 is viewed in plan. As FIGS. 10 and 12 indicate, when viewed in plan, the width of opening 49 in a direction transverse to the outer cannula longitudinal axis varies longitudinally along the length of outer cannula 44, and preferably narrows from the proximal to distal portions of opening 49. When viewed in side elevation, cutting edge 51 slopes in a radially outward direction moving distally along edge 51. As a result, as a tissue sample is distally urged within outer cannula opening 49 by the action of inner cannula 76, the tissue is increasingly compressed in the direction of the circumference of inner cannula 76 (or in the direction of the “width” of opening 49 when viewed in plan). To ensure complete cutting, inner cannula distal end 79 preferably travels to a position that is distal of outer cannula opening 49 during a tissue cutting operation, i.e., there is an inner cannula overstroke.

As mentioned above, tissue cutting device 40 aspirates tissue samples received in inner cannula lumen 78 to cause the tissue samples to move in the proximal direction along the length of the inner cannula 76. In certain methods of use, device 40 is used to resect tissue without collecting tissue samples for further analysis. In such embodiments, a tissue collector need not be provided. In other embodiments wherein tissue collection is desired, device 40 preferably includes a tissue collector 58 into which aspirated tissue samples are deposited during a tissue cutting procedure. Tissue collector 58 may be located remotely from handpiece 42 and outside the sterile field during a tissue cutting operation as shown in FIG. 21A. However, in an alternative embodiment, as best seen in the examples of FIGS. 1-7, tissue collector 58 is removably connected to handpiece 40. In either embodiment, a fluid collection canister 192 is preferably located between tissue collector 58 and a source of vacuum (such as vacuum generator 153 in FIG. 21A) to protect the vacuum generating apparatus from becoming contaminated or damaged by aspirated fluids. In those embodiments that lack a tissue collector, fluid collection canister 192 may be provided to collect both aspirated fluid and tissue.

Referring to FIGS. 4-7, tissue collector 58 is connected to upper housing 52 proximally of the inner cannula 76 to receive the aspirated tissue samples. Tissue collector 58 is a generally cylindrical, hollow body with an interior volume that is in fluid communication with the inner cannula lumen 78 and a source of vacuum (not shown in FIGS. 4-7). Tissue collector 58 is removably secured to housing connector 96 to allow for the periodic removal of collected tissue samples. Tissue collector 58 is preferably secured to upper housing 52 in a manner that provides a substantially leak-proof vacuum seal to maintain consistent aspiration of severed tissue samples. A vacuum hose fitting 59 is formed on the proximal end of tissue collector 58 and is in fluid communication with the interior of tissue collector 58 and with a vacuum generator, as will be discussed below.

In the embodiment of FIGS. 4-5, housing connector 96 is a generally cylindrical, flange extending proximally from upper housing 52. Upper shell 54 and lower shell 56 of upper housing 52 cooperatively define a cavity into which a seal holder 94 is partially disposed. Seal holder 94 includes a distal annular recess in which a seal 92, such as an o-ring, is disposed. Seal holder 94 also includes a central lumen through which inner cannula 76 is slidably disposed. A proximally projecting portion 95 of seal holder 94 projects away from upper housing 52 in the proximal direction and is received within housing connector 96. As best seen in FIGS. 2 and 3, inner cannula proximal end 77 preferably remains within seal holder 94 as inner cannula 76 reciprocates during operation of tissue cutting device 40. However, proximal end 77 moves within seal holder 94 as inner cannula 76 reciprocates. Seal 92 preferably comprises a resilient material such as an elastomeric material. The sealing engagement of seal 92 and inner cannula 76 prevents air or fluids from leaking between inner cannula 76 and upper housing 52 and aids in maintaining consistent aspiration of samples through the inner cannula lumen 78.

Housing connector 96 includes connecting features 98 and 100 which are configured to engage with corresponding connecting features 102 and 104 on tissue collector 58. In the embodiment of FIGS. 4 and 5, connecting features 98 and 100 are “J” shaped slots formed in housing connector 96, and connecting features 102 and 104 are complementary protrusions formed on tissue collector 58 which engage connecting features 98 and 100, respectively. To connect tissue collector 58 to housing connector 96, protrusions 102 and 104 are aligned with slots 98 and 100, and tissue collector 58 is then inserted into housing connector 96 in the distal direction. Tissue collector 58 is then rotated to fully engage protrusions 102 and 104 with slots 98 and 100. A seal 103 is provided around the circumference of tissue collector 58 to sealingly engage the inner surface of housing connector 96.

An alternate embodiment of tissue collector 58 is depicted in FIGS. 6 and 7. In the embodiment of FIGS. 6 and 7, tissue collector 58 is semi-elliptical in cross-section and includes a hollow interior for receiving samples, as in the embodiment of FIGS. 4 and 5. In the embodiment of FIGS. 6 and 7, a cylindrical flange housing connector 96 is not provided. Instead, upper housing 52 is formed with an engagement recess 108 that engages a complementary clip 106 formed on tissue collector 58. In each of the foregoing embodiments, tissue collector 58 may be provided with a filter (not shown) in its interior for collecting solid tissue samples while allowing liquids and gases (e.g., air) to pass through. Exemplary filters include medical grade mesh filters with a mesh size smaller than that of tissue snippets 112.

In the embodiments of FIGS. 4-7, tissue collector 58 preferably has a longitudinal axis that is not collinear with the longitudinal axes of handpiece 42, motor 62, or cam 64. The longitudinal axis of tissue collector 58 is preferably substantially coaxial with the longitudinal axis of inner cannula 76 to yield an “in-line” filter configuration. Tissue collector 58 and inner cannula 76 are both spaced apart from and substantially parallel to the longitudinal axes of handpiece 42, motor 62, and cam 64. Thus, the cutting axis (i.e., the outer cannula longitudinal axis) and sample aspiration path axis are not coaxial with the longitudinal axis of the handpiece 42. As a result, when device 40 is used to cut tissue, the surgeon's view of the cutting axis is not obstructed by his or her hand. In addition, the surgeon can treat the proximal end of the filter as a “gun sight” and align it with a tissue sample to be cut to thereby align the outer cannula 44 with the tissue sample, providing enhanced ergonomic benefits over previous devices, in particular, previous neurosurgical devices. In the case of a device with a remote tissue collector 58 such as the one depicted in FIGS. 21A and 21B, the user can treat the proximal end of upper housing 52 as a gun sight and align it with a target tissue.

When device 40 is used to cut tissue, outer cannula opening 49 must be aligned with the target tissue of interest to receive it for cutting. The entire device 40 can be rotated about the longitudinal axis of handpiece 42 to place outer cannula opening 49 at the desired location. However, this technique can be awkward and may reduce the surgeon's dexterity. Thus, in an exemplary embodiment, device 40 includes a selectively rotatable outer cannula 44. As best seen in FIGS. 18-20, a rotation dial 60 is provided and is rotatably seated in a cavity defined by upper shell 54 and lower shell 56 of upper housing 52. Rotation dial 60 is configured such that when it is rotated, it causes outer cannula 44 to rotate about its longitudinal axis with respect to handpiece 42. Rotation dial 60 is preferably connected to an outer cannula connector portion 88. In the embodiment of FIGS. 18-20, outer cannula connector portion 88 is a sleeve that is integrally formed with rotation dial 60 and which is fixedly secured to outer cannula 44 such as by an adhesive or other known connection means. In the exemplary embodiment of FIG. 20 rotation dial 60 has an outer diameter that is greater than that of sleeve 88.

As mentioned previously, inner cannula 76 includes a hinge 80 to allow inner cannula cutting section 83 to pivot toward outer cannula opening 49 when device 40 is in operation. In order to ensure the correct operation of hinge 80, the circumferential alignment of hinge 80 and outer cannula opening 49 should be maintained. Thus, rotation dial 60 is preferably connected to inner cannula 76 such that when rotation dial 60 is rotated, both outer cannula 47 and inner cannula 76 rotate in a fixed angular orientation with respect to one another by an amount that directly corresponds to the amount by which rotation dial 60 is rotated. Rotation dial 60 may be directly connected to inner cannula 76 or may use an intervening connecting device. However, rotation dial 60 should be configured to allow inner cannula 76 to reciprocate with respect to rotation dial 60. As best seen in FIG. 20, rotation dial inner cannula connector 86 may be provided to connect rotation dial 60 to inner cannula 76. Rotation dial inner cannula connector 86 comprises a proximal sleeve 87 disposed about inner cannula 76 and a distal, radially extending annular flange 90 with an outer diameter greater than that of the sleeve 87. Sleeve 87 and flange 90 may be in the shape of circular cylinders. Alternatively, and as shown in FIGS. 18-19, sleeve 87 and flange 90 may be in the shape of polygonal cylinders. Sleeve 87 is slidably received within the annular cavity 130 at the distal end 126 of the cannula transfer 74 and keyed to the inner surface of cannula transfer 74 at annular cavity 130 such that sleeve 87 can reciprocate with respect to cannula transfer 74 while causing cannula transfer 74 to rotate with sleeve 87 when rotation dial 60 is rotated. When inner cannula 76 is reciprocated, cannula transfer distal end 126 reciprocates with respect to sleeve 87, thereby variably adjusting gap “G” defined within annular cavity 130 (FIG. 20). Alternatively, cannula transfer distal end 126 may be slidably received in an annular cavity formed in sleeve 87 and may be keyed to the inner surface of the annular cavity so that cannula transfer may reciprocate with respect to sleeve 87 while still rotating with sleeve 87 when dial 60 is rotates.

As best seen in FIG. 20, rotation dial 60 includes a first annular cavity 61 that is sized to receive and engage flange 90 in a close fitting relationship. Rotation dial 60 may be press fit to flange 90. In addition, adhesive connections or mechanical connections may be used. Because rotation dial 60 is directly or indirectly connected to both outer cannula 44 and inner cannula 76, both cannulae rotate in direct correspondence to the rotation of rotation dial 60, thereby allowing the user to adjust the orientation of outer cannula opening 49 and inner cannula hinge 80 in a circumferential direction with respect to handpiece 42. As a result, surgeons need not rotate the entire tissue cutting device 40 to obtain the desired angular orientation.

Rotation dial 60, outer cannula 44, and inner cannula 76 are preferably configured for 360° rotation. In addition, tactile indicators are preferably provided on rotation dial 60 to allow a user to reliably determine the extent to which dial 60 has been rotated from a given starting point. The tactile indication may comprise surface features defined on or in the exterior surface of rotation dial 60. In one exemplary embodiment, depicted in FIGS. 18-20, a plurality of ridges 122 is provided around the circumference of rotation dial 60 to provide tactile indication. The ridges also act as grips and facilitate the surgeon's ability to rotate the dial 60 without transferring unwanted motion to the surgical site.

As mentioned previously, vacuum (sub-atmospheric pressure) is applied to tissue collector 58 to aspirate severed tissue samples through inner cannula 76 in the proximal direction. The application of vacuum to inner cannula 76 via tissue collector vacuum hose fitting 59 will have a propensity to produce a vacuum at proximal end 45 of outer cannula 44 if leakage occurs between inner cannula 76 and the components of upper housing 52. The generation of a vacuum at outer cannula proximal end 45 will in turn cause fluids and/or tissue samples at the distal end of outer cannula 44 to flow into the annular clearance between inner cannula 76 and outer cannula 44 that extends from its proximal end at outer cannula proximal end 45 to its distal end at inner cannula distal end 79. This fluid and/or tissue can result in blockage of the annular clearance and increased friction between the inner cannula 76 and outer cannula 44, resulting in degraded performance. Accordingly, a seal 129 is preferably provided to prevent air artifacts, fluid (water, saline, blood, etc.) flow, and tissue sample flow in the annular clearance between inner cannula 76 and outer cannula 44. The seal 129 is preferably disposed adjacent the proximal end of the annular clearance between inner cannula 76 and outer cannula 44, i.e., proximally adjacent to outer cannula proximal end 45. As shown in FIG. 20, seal 129 is preferably annular and circumscribes inner cannula 76, extending from the outer surface of inner cannula 76 in a radially outward direction as well as longitudinally along a portion of the length of inner cannula 76.

In the embodiment of FIG. 20, rotation dial 60 and sleeve 87 act as a seal housing and include a seal cavity 131 which is an annular cavity disposed immediately adjacent to and distal of first annular cavity 61. Seal cavity 131 is sized to accept seal 129 therein. The seal 129 may be a conventional seal such as a solid, flexible and/or elastomeric o-ring. However, seal 129 is preferably amorphous and comprises a thixotropic material that is a semi-solid. It is further preferred that seal 129 fill the entirety of seal cavity 131 to ensure that cavity 131 is substantially leak free. In the exemplary embodiment of FIG. 20, seal cavity 131 has an outer diameter that is greater than the outer diameter of outer cannula 44. Moreover, the annular thickness of seal cavity 131 is preferably greater than the annular clearance between outer cannula 45 and inner cannula 76 to better ensure complete sealing of the annular clearance.

In one exemplary embodiment, seal 129 is a grease—such as the so-called “high vacuum greases”—that is formulated to withstand vacuum conditions. Suitable high vacuum greases include halogenated polymers. The halogenated polymers are preferably based on cyclic ether or unsaturated hydrocarbon polymeric precursors. In one exemplary embodiment, a perfluroropolyether (PFPE) grease is used. Examples of such greases include the FOMBLIN® family of greases supplied by Solvay Solexis, Inc. Other examples of such greases include polytetrafluroroethylene greases (“PTFE”) such as TEFLON® greases supplied by DuPont. One suitable high vacuum grease is FOMBLIN® Y VAC3 grease, which is a PFPE grease with a PTFE thickener. The semi-solid seal 129 preferably has a kinematic viscosity at 20° C. of at least about 500 cSt, more preferably at least about 800 cSt, and even more preferably at least about 1200 cSt. Semi-solid seal 129 preferably has a kinematic viscosity at 20° C. of no greater than about 2500 cSt, more preferably no greater than about 2000 cSt, and even more preferably no greater than about 1700 cSt.

The use of a semi-solid seal 129 has several advantages. Because the seal is semi-solid, it will tend to absorb and dampen vibrations transmitted from the reciprocation of the inner cannula, thereby reducing overall vibration of device 40, and in particular, the vibration transmitted to outer cannula 44. The dampening of such vibrations is particularly beneficial because it reduces the transmission of unwanted vibrations to outer cannula 44 which can disturb delicate neurosurgical procedures. Moreover, because it is not a solid seal, seal 129 will experience less heating and wear as it is frictionally engaged by the reciprocating inner cannula 76. In certain embodiments, a portion of seal 129 will adhere to the outer surface of inner cannula 76 as it reciprocates producing a zero slip velocity condition at the inner cannula 76 outer surface which may further reduce frictional heating and degradation of seal 129. Because semi-solid seal 129 produces less frictional resistance to the reciprocation of inner cannula 76 as compared to conventional solid seals such as o-rings, it also decreases the required motor power consumption and can facilitate the use of lower torque and lower cost motors, which in turn facilitates making device 40 disposable.

In one configuration, device 40 is connected to a vacuum source and configured for variable aspiration, i.e., configured to supply variable levels of vacuum to inner cannula lumen 78. As depicted in FIG. 21A, in one exemplary implementation, a tissue cutting system is provided which comprises tissue cutting device 40, a tissue collector 58, a controller 132, a vacuum generator 153, a vacuum actuator 144, a controllable valve 146, a vacuum line 151, and a fluid collection canister 192. As mentioned previously, in FIG. 21A tissue collector 58 is located remotely from handpiece 42 and may be placed far enough from the handpiece 42 to remain outside of the sterile field during a tissue cutting operation. As best seen in FIG. 21B, tissue collector 58 is generally the same as the tissue collector 58 depicted in FIGS. 4-5. Vacuum line 151 a connects the distal end of tissue collector 58 to proximally projecting portion 95 of seal holder 94 on the proximal end of tissue cutting device upper housing 52. In one arrangement, the proximal end of vacuum line 151 a includes a hose fitting 59 b that is integrally formed with a tissue collector coupler 296. Coupler 296 is similar in structure to tissue collector connector 96 (FIGS. 4-5) and is a cylindrical structure with a hollow interior for receiving a portion of tissue collector 58. As best seen in FIG. 21B, tissue collector 58 includes projections 202 and 204 which engage complementary slots 298 and 200 in coupler 296 in the same manner that projections 102 and 104 engage slots 98 and 100 in FIGS. 4-5. At the proximal end of tissue collector 58, hose fitting 59 a engages vacuum line 151 b which in turn is connected to fluid collection canister 192. Fluid collection canister 192 is connected to vacuum generator 153 via vacuum line 151 c. Vacuum generator 153 is connected to controllable valve 146 by way of pressure line 147.

The outlet of tissue collection canister 192 is preferably substantially liquid free and is connected to vacuum generator 153 via vacuum line 151 c. Thus, vacuum generator 153 is in fluid communication with tissue collector 58 and inner cannula lumen 78, thereby generating a vacuum at the proximal end 77 of inner cannula 76 to aspirate severed tissue samples from inner cannula distal end 79 to tissue collector 58. The level of vacuum generated by vacuum generator is preferably variable and selectively controllable by a user. Maximum vacuum levels of at least about 0 in Hg. are preferred, and maximum vacuum levels of at least about 1 in Hg. are more preferred. Maximum vacuum levels of at least about 5 in Hg. are even more preferred, and maximum vacuum levels of at least about 10 in Hg. are still more preferred. Maximum vacuum levels of at least about 20 in. Hg. are yet more preferred, and vacuum levels of at least about 29 in. Hg. are most preferred.

The controllable valve 146 and the vacuum generator 153 provide a means for continuously adjusting and controlling the level of vacuum applied to tissue collector 58 and the proximal end of inner cannula lumen 78. Controllable valve 146 is supplied with a pressurized gas, preferably air, or an inert gas such as nitrogen. In one exemplary embodiment, the pressure applied to controllable valve 146 is about 70 psi.

The system further includes an electrical controller 132 which receives and provides signals to the various components to control or monitor their operations. Controller 132 provides control signals to device 40 via motor drive control line 142 to activate or deactivate motor 62. An aspiration valve control line 150 extends from the controller 132 to the controllable valve 146 which provides pressure to the vacuum generator 153. Signals to the controllable valve 146 through line 150 are used to control the amount of vacuum applied to tissue collector 58.

Controller 132 also receives electrical signals from the various components of the system. For instance, a pressure transducer 148 associated with the aspiration controllable valve 146, sends a signal along line 152 to the controller 132. The signal is representative of the pressure supplied through controllable valve 146 to vacuum generator 153. Thus, the transducer 148 provides immediate feedback to the controller which can in turn provide signals to aspiration controllable valve 146.

The user can adjust the system operating parameters by using panel controls such as a console knob 138 and/or one or more depressible controllers, such as a foot pedal 144. In one embodiment, foot pedal 144 can be used to activate the motor 62 in device 40, causing the inner cannula 76 to reciprocate within the outer cannula 44. In another embodiment, foot pedal 144 can be used to control the vacuum level supplied from vacuum generator 153 to tissue collector 58 and inner cannula lumen 78. In yet another embodiment, foot pedal 144 can be used both to activate motor 62 and to control the vacuum level supplied from vacuum generator 153 to tissue collector 58. In one arrangement, foot pedal 144 is configured to variably increase the level of vacuum applied to tissue collector 58 from a minimum level to a maximum level as foot pedal 144 is depressed from a first position to a second position. In such an arrangement, the first position is one in which foot pedal 144 is not depressed all or is only slightly depressed, and the second position is one in which foot pedal 144 is fully depressed. In another embodiment, knob 138 is used to set a preselected maximum vacuum level applied by vacuum generator 153. Thus, by depressing foot pedal 144 from a first fully open position to a second fully closed position, a plurality (preferably a continuum) of vacuum levels can be supplied to tissue collector 58 with the maximum vacuum level being user adjustable via knob 138.

In one exemplary embodiment, foot pedal 144 includes two switches (not shown) for providing variable vacuum and activating motor 62. In another exemplary embodiment, once foot pedal 144 is partially depressed from an open or undepressed position, motor 62 is activated. In accordance with the embodiment, continued depression of foot pedal 144 activates vacuum generator 153. Foot pedal 144 preferably provides continuous movement between a fully open and a fully depressed position which in turn corresponds to a plurality, and preferably a continuum, of vacuum levels that are supplied to inner cannula lumen 78. Once foot pedal 144 is fully depressed, the vacuum level supplied to inner cannula lumen 78 corresponds to a previously selected maximum vacuum level.

In certain illustrative examples, the user will adjust the level of vacuum to achieve a desired level of “traction” in the tissue surrounding the tissue to be severed. As used here in, the term “traction” refers to the exertion of a pulling force on tissue surrounding the target tissue to be severed. In some instances, traction may be visualizable by the surgeon with the use of a magnification instrument, such as a microscope or an endoscope. The level of vacuum will also determine the amount of unsevered tissue that is drawn into outer cannula opening 49, and therefore, the size of the severed tissue snippets 112 (FIG. 14). Therefore, when fine shaving operations are desired, the vacuum level will be a relatively lower level than if debulking (large scale tissue removal) is performed. Of course, the pre-selected maximum vacuum level will also affect the maximum size of tissue that is drawn into outer cannula opening 49, and therefore, will affect the maximum size of severed tissue samples during any one operation. Also, the vacuum level may be adjusted based on the elasticity, fibrotic content, and hardness/softness of the tissue.

Console 132 may also include indicator lights 136, one of which indicates the activation of cutting and one of which indicates the activation of aspiration. Console 132 may further include an analog display 140 with readouts for “aspiration” and “cutter.” The “aspiration” read out indicates the vacuum level supplied to tissue collector 58 from vacuum generator 153. The “cutter” read out indicates the speed of reciprocation of inner cannula 76. In one embodiment, a speed sensor is mounted in device 40 to determine the speed of reciprocation of inner cannula 76 and the sensor is input to controller 132.

As mentioned previously, when device 40 is used to perform a cutting operation, inner cannula 76 reciprocates within outer cannula opening 49 to sever tissue received within outer cannula opening 49. When a cutting operation is complete, it may be preferred to have inner cannula 76 come to rest at a position that is proximal of the proximal edge 53 of outer cannula opening 49 to ensure that tissue is not trapped between inner cannula distal end 79 and outer cannula cutting edge 51. However, in certain methods of use, tissue cutting device 40 may be used as an aspiration wand without cutting any tissue. In other words, tissue cutting device 40 is configured as a multi-function surgical device. For example, with respect to use of tissue cutting device 40 as an aspiration wand, the stop position of the inner cannula distal end 79 within outer cannula opening 49 determines the open area of the outer cannula 44, and therefore, the aspiration levels that can be applied immediately adjacent outer cannula opening 49. Thus, in some preferred embodiments, the inner cannula stop position is user adjustable. Tissue cutting device 40 may be used to aspirate a variety of fluids associated with a neurosurgical procedure, including without limitation blood, saline, cerebrospinal fluid, and lactate ringer's solution. In certain examples, the inner cannula stop position is adjusted to provide a desired degree of aspiration, outer cannula 44 is positioned proximate a target tissue, and vacuum is applied to manipulate the target tissue and draw it into outer cannula opening 49. Outer cannula 44 is then moved to a desired location or orientation, thereby moving the target tissue to the desired location or orientation. Once the target tissue has been satisfactorily manipulated, a cutting operation is initiated. By using device 40 in this manner, target tissues can be drawn away from areas where tissue cutting operations are undesirable, and the cutting can be performed remotely from those areas.

Outer cannula 44 of tissue cutting device 40 may also be used as a blunt dissector, tissue retractor/tissue elevator, or a vessel tamponade. Each will be discussed in turn.

Because the distal end of outer cannula 44 does not generate heat, has an atraumatic profile, a rigid column strength and has a small tissue receiving aperture 47, outer cannula 44 may be used as a blunt dissector to move or manipulate tissue to position tissue for cutting. More specifically, when used for tissue manipulation, outer cannula 44 may be manipulated to allow a user to scrape tissue from a structure, such as critical vessels, thereby minimizing or even preventing any damage to such structures. In one exemplary procedure, tissue cutting device 40 may be deactivated such that inner cannula 42 stops moving. In this configuration, aperture 47 on outer cannula 44 may be used as a rake to pull across tissue and rake tissue off critical structures and/or vessels. Additionally, the user may vary the aggressiveness of this action by the lack of vacuum being delivered to aperture 47 or by varying the amount of vacuum being delivered to the aperture 47, as well as the amount of downward force applied to the subject tissues. Furthermore, the profile of aperture 47 is configured to enhance this action. In other exemplary procedures, a user may use outer cannula 44 to as a tissue retractor and/or a tissue elevator to manipulate and/or move tissue during the procedure, without introducing new surgical devices and without requiring removal of tissue cutting device 40. For example, because no heat is generated at the distal end of outer cannula 44, it may be used to lift or otherwise move (by pushing or pulling) selected tissue.

It is important to note that outer cannula 44 may or may not use vacuum to assist in manipulation of tissue. For example, in one exemplary configuration, inner cannula 44 may be deactivated such that a distal end of inner cannula 44 is positioned proximally of distal opening 47, but a user determined level of vacuum may be supplied to distal opening 47. In this manner of operation, vacuum may be used to pull tissue away from critical structures such that vacuum is used as the retraction mechanism or the tissue holding mechanism in the same way that the introduction of a separate suction cannula device would be used and/or the introduction of a separate tissue grasper device would be used.

In another exemplary use, outer cannula 44 may also be used as a vessel tamponade. In this application, outer cannula 44 may be selectively pressed on a vessel to assist in providing direct pressure on the offending vessel to control and stop bleeding, as the outer cannula 44 does not generate heat. In yet another use, vacuum may be simultaneously applied to aperture 47 to evacuate the field of the surgical site prior and/or during the use as a tamponade so that the user may be able to visualize and determine the exact location of the offending vessel that requires hemostasis. Furthermore, since aperture 47 is configured on the side of outer cannula 44, the distal end of outer cannula 44 or the non-aperture side of outer cannula 44 may be used as the tamponade, for example.

It should be understood that, in addition to resecting abnormal tissue (such as a tumor), outer cannula 44 may be used in the above described manners when tissue cutting device 40 is not activated or even when tissue cutting device 40 is activated, thereby making tissue cutting device 40 a multi-functional tool. Further, as also stated above, because tissue cutting device 40 may be used in multiple manners, it is also advantageous that such multiple uses may be done without requiring removal of tissue cutting device 40. In other words, multiple uses of tissue cutting device 40 may be employed with a single insertion of tissue cutting device 40 into a patient, thereby minimizing trauma to a patient and providing for shorter durations of surgical procedures.

It is also important that the multiple uses of tissue cutting device 40 (i.e., tissue resection, blunt dissector, tissue retractor, tissue elevator, vessel tamponade) may be performed in a serial fashion, and even simultaneously. For example, in one exemplary arrangement outer cannula 44 may be used to retract tissue from a critical structure, vacuum may be used to aspirate fluid from the surgical site to clear the field and then tissue cutting device 40 may be activated to resect target tissue. Because tissue cutting device 40 may be used in a variety of manners, tissue cutting device 40 also allows flexibility for a user to vary his/her approach to each surgical situation.

In one exemplary system, an inner cannula position control is provided which controls the rest position of inner cannula 76 when motor 62 is deactivated. Referring to FIG. 24, cam rotational position indicators 176 a and 176 b are mounted on the proximal end of cam 62. In an exemplary embodiment, cam rotational position indicators 176 a and 176 b are magnets having opposite poles. A position sensor 174 is mounted on the inner surface of cam housing 69 and generates a signal indicative of the rotational position of indicators 176 a and 176 b relative to position sensor 174. As mentioned previously, the rotation of cam 62 correlates directly to the position of inner cannula 76 within outer cannula 44. Thus, the rotation of cam 62 can be sensed to indirectly determine the position of inner cannula 76. Accordingly, indicators 176 a/176 b and sensor 174 can be used to determine the position of inner cannula 76 with respect to proximal edge 53 of outer cannula opening 49 (FIGS. 10-12).

Referring to FIG. 22, an embodiment of a system for controlling the operation of tissue cutting device 40 is provided. The system includes a main control unit 158 (“MCU”), which (in the embodiment shown) is configured as a microprocessor-based system. In one implementation, MCU 158 is incorporated in controller 132 (FIG. 21A) and is operable to control the various operations of the tissue cutting device 40. Foot switch 144 is electrically connected to a number of inputs of MCU 158 via an equal number, K, of signal paths 156, wherein K may be any integer. Panel controls, such as knob 138, are electrically connected to a number of inputs of MCU 158 via an equal number, J, of signal paths 145, wherein J may be any integer.

Display unit 140 is electrically connected to a number of outputs of MCU 158 via an equal number, Q, of signal paths 141, wherein Q may be any integer. In one exemplary implementation, depicted in FIG. 21A, display unit 140 is provided on console 134.

As mentioned previously, tissue cutting device 40 includes motor 62 coupled to the inner cannula 76 by an inner cannula drive assembly 63. The motor 62 is electrically connected to motor control unit 160 via a number, M, of signal paths 161 wherein M may be any integer. The motor control unit 160 is, in turn, connected to a number of outputs of MCU 158 via an equal number, N, of signal paths 161. Cam rotational position sensor 174 is electrically connected to a motor shaft position feedback input (SPF) of MCU 158 via signal path 162, and provides a motor stop identification signal thereon as will be more fully described hereinafter. The motor shaft stop identification signal provided by sensor 174 on signal path 162 preferably provides MCU 158 with a motor stop identification signal and may optionally provide a cutter speed signal that is proportional to the motor speed for a geared system or identical to the motor speed for a direct drive system.

Handpiece 40 is further mechanically connected to a vacuum unit 168 (e.g., a combination of controllable valve 146 and vacuum generator 153 in FIG. 21A) via conduit 163, whereby the vacuum unit 168 provides a controllable vacuum level to handpiece 40 for aspirating tissue received in inner cannula lumen 78. Vacuum unit 168 is electrically connected to a vacuum control unit 166 via a number, P, of signal paths 169 wherein P may be any integer. The vacuum control unit 166 is, in turn, connected to a number of outputs of MCU 158 via an equal number, L, of signal paths 167, wherein L may be any integer. A vacuum sensor 164, which may be a temperature compensated solid-state pressure sensor, may be positioned within the conduit 151 and electrically connected to a vacuum feedback (VF) input of MCU 158 via signal path 165. Alternatively, the vacuum sensor 165 may be disposed within hand piece 42 or within the vacuum unit 168 itself.

In operation, the MCU 158 is responsive to a vacuum command signal, preferably provided by a corresponding control mechanism associated with control panel 132, foot pedal 144, or an equivalent control mechanism, to provide one or more corresponding vacuum control signals to vacuum control unit 166 along signal paths 167. The vacuum control unit 166, in turn, is responsive to the one or more vacuum control signals to activate the vacuum unit 168 to thereby provide tissue cutting device 40 with a desired level of vacuum. The actual vacuum level provided to tissue cutting device 40 is sensed by vacuum sensor 164, which provides a corresponding vacuum feedback signal to the vacuum feedback input VF of MCU 158. The MCU 158 is then operable to compare the vacuum feedback signal with the vacuum command signal and correspondingly adjust the one or more vacuum control signals to achieve the desired vacuum level within tissue cutting device 40. Such closed-loop feedback techniques are well known in the control systems art.

In one alternative embodiment, the MCU 158 can be replaced by individual microprocessors controlling the input and output for controlling the operation of the motor 62 and the vacuum unit 168. In this alternative embodiment, the motor control and vacuum control microprocessors can be PIC16CXX Series microcontrollers provided by Microchip, Inc. of Chandler Ariz. The motor control microcontrollers can receive input signals from the motor driver 172 (FIG. 23) and position sensor 174, as well as the foot switch 144 and panel controls 132. Likewise, the vacuum microcontroller can receive input signals from the vacuum sensor 164, the foot switch 144 and panel controls 138. Each microcontroller can provide its own output to its driven component and have its own display, such as an LED display, indicative of its operational status. Moreover, the two units can communicate with each other to ensure clean cutting by proper timing of the cutting and aspiration functions.

Referring now to FIG. 23, one exemplary embodiment of the motor control unit 160 is shown in greater detail. The motor control unit 160 in one embodiment includes a pulse width modulation (PWM) generator circuit 170 having a motor speed input connected to one of the MCU outputs 161 ₁. If motor speed control is provided, the output 161 ₁ can provide a variable voltage signal indicative of a desired motor speed and based upon the position of a throttle, foot pedal, or other actuator. In certain embodiments, an additional input is connected to another one of the MCU outputs 161 ₂. The signal at this output 161 ₂ can be a motor slowdown signal as described below. Alternatively, the output 161 ₂ can constitute a braking signal used in connection with a current feedback motor controller. As a further alternative, the slowdown command may be communicated via the motor speed command itself, rather than through a separate signal 161 ₂. In this instance, the output 161 ₂ may not be required.

In the illustrated embodiment, the PWM is disposed within the motor control unit 160. Alternatively, the PWM can be integrated into the MCU 158, or into the separate motor control microprocessor discussed above. In embodiments that include motor speed control, the motor speed input receives a motor speed signal from MCU 158 indicative of desired operational speed of the motor 62. The slowdown input can receive a speed adjustment signal from the MCU 158 based on an actual motor speed signal provided by a motor sensor associated with the motor 62.

A motor driver circuit 172 is electrically connected to PWM generator circuit 170 via signal path 173 and receives a PWM drive signal therefrom, which is a pulse width modulated signal indicative of desired motor speed. The motor driver circuit 172 provides a motor drive signal (MD) to motor 62 via signal path 175. While the disclosed embodiment contemplates digital control of the motor using the PWM generator circuit 170, alternative embodiments can utilize closed loop feedback analog circuits, particularly where slower cutting speeds are contemplated.

The motor drive signal includes a motor stop input that is connected to another one of the MCU outputs 161 ₁. In accordance with an aspect of the present disclosure, MCU 158 provides a motor stop signal on signal path 161 ₃, based on a motor deactivation command provided by foot switch 144 or panel control 138 and also based on a motor stop identification signal provided by sensor 174, to stop the inner cannula 76 in a desired position, as will be more fully described hereinafter. In certain embodiments, only the motor stop signal is utilized to command the motor to stop at the predetermined position. In these certain embodiments, the motor slowdown signal on path 161 ₂ can be eliminated, or the input on path 161 ₂ can be used for other control signals to the motor control circuit.

As mentioned previously, when tissue cutting device 40 is deactivated, inner cannula 76 may come to rest partially disposed within outer cannula opening 49. Referring to FIGS. 25-27, three different stop positions of inner cannula 76 are shown. FIG. 27 shows that inner cannula 76 can be stopped in a position in which a portion of the tissue T is trapped between the outer cannula opening 49 and the inner cannula distal end 79. Efforts at withdrawing outer cannula 44 from the surgical site may accordingly result in tearing of the tissue portion T′ away from the surrounding tissue base T. Surgeons encountering such trapping would typically be required to re-activate tissue cutting device 40 to release the tissue portion T′ from the surrounding tissue base T. To prevent such tissue trapping from occurring, deactivation of the motor 62 is controlled in such a manner that the inner cannula distal end 79 is positioned remotely from the outer cannula opening 49 when inner cannula 76 stops reciprocating. However, in certain methods of use, device 40 is used as an aspiration wand. In those methods, the stop position of inner cannula distal end 79 may be adjusted to different locations within outer cannula opening 49 in order to adjust the level of aspiration supplied to a region of the anatomy proximate outer cannula opening 49. For example, stop positions may be selected that limit the percent open area of outer cannula opening 49 to 25%, 50%, or 75% of the total area of opening 49.

Referring again to FIGS. 23 and 24, controlled deactivation of the motor 62 will now be described in detail. When it is desired to deactivate tissue cutting device 40, a motor stop command is provided such as via foot switch 144 or a panel control 138. In one embodiment, MCU 158 is responsive to the motor stop command to provide a slowdown signal to the PWM generator via signal path 161 ₂ which slows the action of motor 62. Preferably, the slowdown signal corresponds to a predefined signal level operable to drive the motor 62 at a motor speed below a motor speed threshold level. Since motor 62 is a brushed DC motor, it has a rotational resistance or resistive torque associated therewith as described above. In addition, in some cases friction between the inner cannula 76 and outer cannula 44 will increase the rotational resistance. Due to this combined rotational resistance, operation of the motor 62 will cease very rapidly or nearly instantly if the motor drive signal on signal path 142 is disabled while driving motor 62 below the motor speed threshold. Accordingly, when device 40 is used to cut tissue, alignment of position indicators 176 a or 176 b with sensor 174 preferably corresponds to a position of the tissue cutting device 40 at which there is no danger of trapping tissue between inner cannula distal end 79 and the outer cannula opening 49, and sensor 174 is operable to produce the motor stop identification signal when so aligned with indicator 176 a or 176 b.

In one embodiment, MCU 158 is operable to produce a motor stop signal on signal path 161 ₃ when sensor 174 detects alignment of position indicators 176 a or 176 b therewith after one passage thereby of indicator 176 a or 176 b since producing the slowdown signal on signal path 161 ₂. Allowing one passage of indicator 176 a or 176 b by sensor 174 after issuing the slowdown signal ensures that the rotational speed of motor 62 is at or below the motor speed threshold when subsequently issuing the motor stop command, regardless of the position of indicator 176 a or 176 b relative to sensor 174 when the slowdown command was issued. After one passage of indicator 176 a or 176 b by sensor 174 since issuing the slowdown signal, MCU 158 is responsive to the signal provided by sensor 174 indicative of alignment of indicator 176 a or 176 b therewith, to produce the motor stop signal on signal path 161 ₃. The motor driver 172 is responsive to the motor stop signal to produce a motor disable signal on signal path 175. Due to the inherent rotational resistance, motor 62 is responsive to the motor disable signal to immediately cease operation thereof with indicator 176 a or 176 b substantially aligned with sensor 174, and with the inner cannula 76 accordingly positioned so as not to trap tissue between inner cannula distal end 79 and the outer cannula opening 44.

As mentioned above, in one exemplary embodiment, the inner cannula stop position is user adjustable, such as by adjusting a panel control 138 on console 134. In accordance with the embodiment, it is contemplated that the stopped rotational position of cam 64, and therefore the inner cannula distal end 79, may be instead aligned with a predetermined differential distance between the indicator 176 a/176 b and the sensor 174. The braking characteristics of the inner cannula 76 and motor 62 can be ascertained and the stopping distance determined so that this predetermined differential distance can be calibrated accordingly. However, in a preferred embodiment, when inner cannula 76 comes to rest, the distal end 79 is located proximally of the outer cannula opening 44 by a predetermined distance, as shown in FIG. 26.

A method of using device 40 to perform a tissue cutting procedure will now be described in the context of a neurosurgical procedure involving the cutting of a neurological target tissue. In one example, the target tissue is brain tissue, and in another example the target tissue is spinal tissue, for example, the tissue of an intervertebral disk. In certain exemplary methods, the tissue specimen being cut is a tumor or a lesion.

In accordance with the method, it is first determined whether the cutting operation will be a debulking operation, a fine shaving operation, or a cutting operation that is somewhere in between a debulking and fine shaving operation. A surgical access path is then created to the tissue sample of interest. In one embodiment, the surgical path is created and/or the target tissue is accessed using an “open” procedure in which the target tissue is open to the atmosphere (e.g., a full open craniotomy). In another embodiment, the surgical path is created and/or the target tissue is accessed using a “closed” procedure in which the target tissue is sealed from the atmosphere.

At this point, the distal end 79 of inner cannula 76 is located proximally of outer cannula opening 69 due to the use of an inner cannula stop position control of the type described previously. The maximum vacuum level to be applied to device 40 is then set using panel controls 138. Generally, higher vacuum levels will be used for debulking procedures than for fine shaving procedures as higher vacuum levels will tend to draw relatively larger sections of tissue into outer cannula opening 49. In one embodiment, the panel control 138 is a knob on console 134 that is rotated to set the desired maximum vacuum level.

In one arrangement, device 40 is configured to be gripped with a single hand during a tissue cutting procedure. Thus, the surgeon will grasp handpiece 42 in the fingers of one hand and insert outer cannula 44 to a location proximate the target tissue. Depending on the hand and the surgeon's orientation with respect to the target tissue, the surgeon may then rotate dial 60 to rotate outer cannula 44 about its own longitudinal axis and orient outer cannula opening 49 immediately adjacent the target tissue. The rotation of outer cannula 44 with dial 60 causes inner cannula 76 to rotate such that a fixed rotational or angular relationship is maintained between inner cannula 76 and outer cannula 44. Once the opening is in the desired orientation, the motor 62 is activated, for example, by beginning to depress pedal 144 from its fully undepressed (open) position to a second partially depressed position which causes motor control unit 160 to send a signal to motor 62 on signal path 142. Motor 62 may also be activated by a panel control 138. The rotation of motor 62 causes cam 64 to rotate, resulting in the reciprocation of cam follower 68 and cam transfer 72. The reciprocation of cam transfer 72 causes cannula transfer 74 to reciprocate, thereby reciprocating inner cannula 76 within outer cannula lumen 110.

Once motor 62 is activated, vacuum is supplied to inner cannula lumen 78. In one embodiment, as the pedal 144 is further depressed (beyond the position at which motor 62 is activated), vacuum generator 153 is activated. The surgeon then adjusts the degree of depression of the foot pedal 144 to obtain the desired level of vacuum by visualizing the movement of the target tissue relative to the outer cannula opening 49. In certain embodiments, the surgeon controls the vacuum level to obtain a desired amount of traction in the tissue surrounding the target tissue. If the surgeon desires to apply the previously set maximum vacuum level, he or she depresses pedal 144 to its fully depressed position.

If desired, the surgeon may depress and partially release the pedal 144 a number of times to manipulate the target tissue in a satisfactory manner. Vacuum controller 166 is manipulable to adjust the setpoint of vacuum generator 153 which is manipulable to adjust the inner cannula vacuum level along a continuum of levels below the pre-selected maximum level. In one embodiment, the extent of depression of foot pedal 144 dictates the vacuum set point supplied to vacuum control unit 166 on signal path 167, and therefore, the amount of vacuum provided by vacuum unit 168. Vacuum sensor 164 measures the vacuum supplied to tissue collector 58 and feeds a signal back to main control unit 158 on signal path 165. The measured vacuum is then compared to the set point applied to vacuum control unit 166 via foot pedal 144, and the signal transmitted to vacuum generator 153 is then adjusted to move the measured vacuum value towards the set point. To obtain a vacuum level equal to the maximum pre-set level, pedal 144 is completely depressed. Maximum vacuum levels of at least about 0 in Hg. are preferred, and maximum vacuum levels of at least about 1 in Hg. are more preferred. Maximum vacuum levels of at least about 5 in Hg. are even more preferred, and maximum vacuum levels of at least about 10 in Hg. are still more preferred. Maximum vacuum levels of at least about 20 in. Hg. are yet more preferred, and vacuum levels of at least about 29 in. Hg. are most preferred.

Due to the resistance of the tissue drawn into outer cannula opening 49, cutting section 83 pivots about hinge 80 and toward outer cannula opening 49 as inner cannula 76 travels in the distal direction. The inner cannula cutting section 83 continues to pivot as it travels in the distal direction, eventually compressing tissue within outer cannula opening 49 and severing it. The severed tissue forms a continuum of tissue snippets 112 (FIG. 14) within inner cannula lumen 78. Due to the vacuum applied to tissue collector 58, snippets 112 are aspirated through inner cannula lumen 78 in the proximal direction. They eventually exit inner cannula lumen 78 at inner cannula proximal end 77 and enter tissue collector 58 (or fluid collection canister 192 if no collector 58 is provided). Any fluids that are aspirated exit tissue collector 58 and are trapped in fluid collection canister 192. The surgeon preferably severs tissue at a cutting rate of at least about 1,000 cuts/minute. Cutting rates of at least about 1,200 cuts/minute are more preferred, and cutting rates of at least about 1,500 cuts/minute are even more preferred. Cutting rates of less than about 2,500 cuts/minute are preferred. Cutting rates of less than about 2,000 are more preferred, and cutting rates of less than about 1,800 cuts/minute are even more preferred.

The surgeon may move device 40 around the target tissue until the desired degree of cutting has been completed. Motor 62 is then deactivated, for example, by completely releasing pedal 144 so it returns to its fully undepressed (open) position. If an inner cannula stop position control is provided, inner cannula 76 preferably comes to rest proximally of outer cannula opening 49, as shown in FIG. 26. Outer cannula 44 is then removed from the surgical site. Tissue collector 58 is then removed from upper housing 52 of handpiece 42, and the collected tissue samples are either discarded or saved for subsequent analysis. Fluids collected in canister 192 are preferably discarded. If the remote tissue collector of FIG. 21A is used, tissue samples may be removed from it without removing outer cannula 44 from the surgical site or otherwise disturbing the surrounding tissue.

Certain target tissues can be difficult to access and may require the surgeon to approach the target tissue on a non-linear path. For example, a non-linear approach may be required during a craniotomy if the craniotomy placement is not convenient relative to the target tissue. In other cases, tumors sometimes develop appendages that extend beyond the primary body of the tumor, and non-linear approaches are required to completely resect the primary body and appendages. Also, in certain instances, the extent of the pathology may be greater than suggested by initial imaging, requiring non-linear surgical approaches to remove all of the diseased tissue. Critical structures such as arteries and nerves or bone structures may also impede access to a target tissue, thus requiring a non-linear approach. In such cases, it may be desirable to have a curved outer cannula and inner cannula to reach the target tissue. While certain known materials of cannula construction are capable of being bent into a desired curved shape, excessive friction may develop between the outer surface of the inner cannula and the inner surface of the outer cannula if measures are not taken to reduce the extent of contact between the inner cannula and outer cannula. Discussed below are embodiments of an inner cannula which reduces such contact.

Referring to FIGS. 28-31, a curvable inner cannula 276 is depicted which is suitable for reciprocation within a curved outer cannula. Inner cannula 276 is similar to inner cannula 76. However, it includes a bending portion 285 located between a proximal end 277 and a distal end 279. Inner cannula 276 is generally rigid, but is deformable at least along bending portion 285 so as to allow for bending of the inner cannula, as shown in FIG. 36. In general, portions of inner cannula 276 which correspond to analogous portions of inner cannula 76 have been numbered with a corresponding “200” series number (e.g., proximal end 77 of inner cannula 76 corresponds to proximal end 277 of inner cannula 276).

Bending portion 285 may be configured in a number of ways, but generally involves a region of reduced inner cannula surface area per unit of axial length along a section of the length of inner cannula 276. In one example, depicted in FIGS. 28-29, bending portion 285 comprises two spaced apart walls 289 a and 289 b. Spaced apart walls 289 a and 289 b are partially cylindrical in shape (i.e., they comprise a cylinder sectioned along the diameter of inner cannula 276 or sectioned along a chord across the cross-section of inner cannula 276). As shown in FIG. 31, walls 289 a and 289 b define a cross-section having the appearance of arcs in facing opposition to one another. Of course, bending portion 285 could also comprise fewer than two walls or more than two walls, depending on the needs of the particular tissue cutting device.

Walls 289 a and 289 b may be spaced apart from one another in a variety of different directions and with a variety of different circumferential spacings. In the example of FIGS. 28-31, walls 289 a and 289 b are spaced apart in a direction along the z-axis, which is perpendicular to the y-axis about which hinge 280 pivots when inner cannula 276 reciprocates within outer cannula 44. Other orientations are also possible. In one example, walls 289 a and 289 b are spaced apart in a direction (the y-direction) that is parallel to the pivot axis of hinge 280. In another example, walls 289 a and 289 b are spaced apart in a direction that forms an acute or obtuse angle with respect to the pivot (y) axis of hinge 280.

The inner cannula 276 of FIGS. 28-31 is formed by relieving two partially-cylindrical sections 291 a and 291 b along bending portion 285. The relieved sections are shown with reduced weight lines in FIG. 31. Thus, inner cannula 276 is integrally formed to include bending portion 285. However, other constructions may also be used. For example, bending portion 285 may comprise a separately formed component that is subsequently attached (e.g., by an adhesive, mechanical fastener, soldering, welding, etc.) at its proximal and distal ends to the portions of inner cannula 276 which are proximal and distal of bending portion 285, respectively. In the embodiment shown in FIG. 28, the relieved section has a length that extends axially along the inner cannula. The length of the relieved section has a length that is greater than the length of the hinge 280.

As indicated in FIG. 31, in one example, spaced apart walls 289 a and 289 b have substantially equal cross-sectional surface lengths (i.e., the circumferential distance traveled along the surface of each wall from one side of the wall to the other side of the wall at a constant axial position along the y-axis). However, other geometries may be used, including those in which the cross-sectional surface lengths of the walls 289 a and 289 b are not equal. In addition, bending portion 285 may comprise walls of different lengths or the equal lengths depicted in FIG. 31.

The amount of surface area relieved from inner cannula 276 is preferably selected to provide a desired degree of bending and rigidity under anticipated surgical conditions. In one example, depicted in FIG. 30a , the relieved sections 291 a and 291 b define a cumulative relieved radial distance, z₁+z₂ (where z₁ and z₂ are circular segment heights of relieved sections 291 a and 291 b), that is at least about 45 percent to about 65 percent of the inner cannula 276 outer diameter, more preferably from about 52 percent to about 62 percent of the inner cannula 276 outer diameter, and still more preferably from about 55 percent to about 60 percent of the inner cannula 276 outer diameter. The “cumulative” relieved radial distance refers to the sum of the relieved radial distances along a common diameter (i.e., collinear radial distances). Thus, in the example of FIGS. 30 a and 30 b, there are two relieved radial distances, z₁ and z₂, along a common diameter, and the cumulative relieved radial distance equals their sum, z₁+z₂.

The length of bending portion 285 is preferably selected to conform to the length of a curved portion of outer cannula 44. In one embodiment, the bending portion 285 has a length that is from about 65 percent to about 90 percent of the length of inner cannula 276, preferably from about 70 percent to about 85 percent of the length of inner cannula 276, and more preferably from about 72 percent to about 82 percent of the length of inner cannula 276. In other examples, bending portion 285 may comprise a smaller percentage of the overall length of inner cannula 276 if a more pronounced degree of curvature is required. Thus, in certain examples, bending portion 285 has a length that is from about 20 percent to about 50 percent of the length of inner cannula 276, and preferably from about 30 percent to about 40 percent of the length of inner cannula 276.

When bending portion 285 is formed by relieving a portion of inner cannula 276, it can be done in a manner that creates a sharp angle when viewed in a longitudinal plan view, such as is shown for the exemplary hinges 80 and 280. However, a more gradual relieving transition may also be used. Referring to FIG. 30a , proximal bending portion relief transition sections 293 a and 293 b are shown. As indicated in the figure, relief transition sections 293 a and 293 b have a curved profile when inner cannula 276 is viewed in a top plan view. The depicted relief transition sections 293 a and 293 b each have a radius of curvature that is generally from about 10 percent to about 40 percent of the outer diameter of inner cannula 276. Radii of curvature that are from about 20 percent to about 30 percent of the inner cannula diameter are more preferred, and radii of curvature that are from about 22 percent to about 26 percent are even more preferred. Distal bending portion relief transition sections 295 a and 295 b may be configured in a similar fashion, but need not have the same shape or radius of curvature of proximal bending portion relief transition sections 293 a and 293 b.

Referring to FIGS. 38-40, an alternate embodiment of an inner cannula 576 with a bending portion 585 is depicted. Bending portion 585 is disposed between the proximal inner cannula end 577 and hinge 580. As with the previous embodiment, portions of inner cannula 576 corresponding to analogous portions of inner cannula 76 have been assigned a “500” series number that corresponds to number of the analogous feature of inner cannula 76. Unlike the embodiment of FIGS. 28-29, bending portion 585 does not comprise two spaced apart walls. Instead, it comprises one partially cylindrical wall 589, as indicated in FIG. 40. In the embodiment of FIGS. 38-39, inner cannula 576 is relieved to define a partially-cylindrical relief section 591 that is complementary to partially-cylindrical wall 589. The relieved section 591 has a length that extends axially (in the y-direction) along the inner cannula. The length of the relieved section has a length that is greater than the length of the hinge 280, as shown in FIG. 38. Hinge 80 and partially cylindrical wall 589 may be oriented in various ways with respect to one another and may define a variety of relative circumferential orientations. In the embodiment of FIGS. 38-39, bending portion 585 is bendable about a bending axis that is parallel to the pivot axis about which hinge 580 pivots (i.e., the x-axis, which projects into and out of the page in FIGS. 38 and 39). As indicated in FIG. 40, partially-cylindrical wall 589 has a plane of symmetry 593 that extends along its length (i.e., in the x-direction). Similarly, hinge 580 has a plane of symmetry 595 that extends along its length (in the x-direction). The intersection of plane of symmetry 593 and partially cylindrical wall 589 defines a first intersection line along the length of partial cylindrical wall 589 (in the y-direction). Similarly, the intersection of plane of symmetry 595 and hinge 580 defines a second intersection line along the length of hinge 580 (in the y-direction). The first and second intersection lines are preferably parallel to one another. However, they first and second intersection lines are more preferably substantially collinear. In the embodiment of FIGS. 38-41, the first intersection line defined by the intersection of partially cylindrical wall 589 and plane of symmetry 593 is substantially collinear with the second intersection line defined by the intersection of the hinge partially cylindrical wall 580 and plane of symmetry 595. However, the planes of symmetry 593 and 595 may also intersect at an angle, such as when the partially cylindrical walls 593 and 595 are circumferentially spaced apart from one another by an amount other than 180°.

As shown in FIGS. 39 and 40, the intersection of the plane of symmetry 593 and partially cylindrical wall 589 defines a partially cylindrical wall height, “h.” The height h is generally from about 30% to about 45% of the inner cannula outer diameter, preferably from about 33% to about 42% of the inner cannula outer diameter, and more preferably from about 35% to about 40% of the inner cannula outer diameter. In one example, the height h is about 39% of the inner cannula outer diameter.

As best seen in FIG. 39, inner cannula 576 includes distal bending portion transition sections 597 a and 597 b (not visible in FIG. 39) which define the transition between the portion of inner cannula 576 that is proximal to bending portion 585. Similar transitions (not shown) may also be provided between bending portion 585 and the portion of inner cannula 576 that is proximal to bending portion 576. When viewed in side elevation, the transitions may be sharp (as with hinge 580) or gradual. Gradual transitions may be linearly sloped, concave, convex, or a variety of other shapes. In the embodiment of FIG. 39, bending portion transition section 597 a defines a concave shape when viewed from a side elevational view (i.e., in a direction perpendicular to the length of inner cannula 576). Transitions 597 a and 597 b define a radius of curvature that is generally from about 45 percent to about 85 percent, preferably from about 50 percent to about 80 percent, more preferably from about 60 percent to about 70 percent, and even more preferably from about 65 percent to about 70 percent, of the outer diameter of inner cannula 576. Bending portion 585 may be integrally formed with inner cannula 576 or it may be separately attached to proximal and distal sections of inner cannula 576. In the embodiment of FIGS. 38-39, bending portion 585 is integrally formed with inner cannula 576 by forming inner cannula 576 and then removing partial cylindrical section 591.

Tissue cutting device 40 may be provided with a curved outer cannula and inner cannula 276 or 576, wherein bending portion 285, 585 has a length and curvature that conforms to the length and curvature of the outer cannula. However, in one example, tissue cutting device 40 is provided with the straight outer cannula 44 depicted in FIG. 1 and a curvable inner cannula 276, 576. Providing tissue cutting device 40 in this manner provides the surgeon with the option of using a straight outer cannula or a curved outer cannula, as dictated by the particular surgical procedure. Outer cannula 44 and inner cannula 276, 576 are preferably made of a deformable material, such as a medical grade steel that remains dimensionally stable after deformation. Thus, in one example, with the inner cannula 276, 576 disposed within outer cannula 44, the surgeon may bend outer cannula 44 to obtain the desired shape. As a result, inner cannula 276, 576 will also bend along bending portion 285, 585 in general conformity with the shape of outer cannula 44. In one illustration, the surgeon may bend the outer cannula 44 using his hand(s) but without the aid of any external bending device. In another illustration, an external bending device is used.

Referring to FIGS. 32-34, a tube bender 410 is depicted. Tube bender 410 is used to bend outer cannula 44 and inner cannula 276, 576 to a desired shape in conformity with a bending surface included on tube bender 410. Tube bender 410 is preferably shaped and configured to bend outer cannula 44 and inner cannula bending portion 285 to a desired shape.

Tube bender 410 includes a proximal end 402, a distal end 404, and comprises a generally arcuate proximal section 411 and a generally linear distal section 413. Proximal section 411 includes a bending surface 408 which is used to impart a desired curved shape to outer cannula 44 and inner cannula bending portion 285, 585. Distal tube bender section 413 comprises an outer cannula retainer 406. Outer cannula retainer 406 is preferably configured to restrict the vertical movement of outer cannula 44, i.e., in a direction that is orthogonal to the upper surface of retainer 406. In the example of FIGS. 32-36, cannula retainer 406 includes a channel, such as lumen 420, along its length through which outer cannula 44 projects. Lumen 420 is sized to receive and accommodate outer cannula 44 and preferably provides a generally snug fit. In other examples, cannula retainer 406 may include a channel that is open on either side of tube bender 410 instead of a fully enclosed lumen. Any other structures that are suitable for retaining the outer cannula 44 to facilitate bending are also possible. For example, in FIGS. 32-35, outer cannula retainer 406 is a unitary structure. However, it may also comprise two or more spaced apart segments along the length of tube bender 410.

Recess 412 is also provided along distal tube bender section 413 and is located between the retainer distal end 418 and tube bender distal end 404. A stop surface 414 is also provided proximally of tube bender distal end 404 and limits the travel of outer cannula 44 with respect to tube bender 410 when outer cannula 44 is disposed in retainer 406. Recess 412 allows the user to see the distal end 47 of outer cannula 44 to verify its complete insertion in retainer 406.

Tube bender 410 is generally lightweight and rigid. Suitable materials of construction include plastics. One exemplary class of suitable plastics is polycarbonates.

Tube bender proximal section 411 also includes a user engagement surface 409 which is spaced apart from bending surface 408 in the radial direction defined by the curvature of proximal section 411. User engagement surface 409 provides a bearing surface against which a user can press his or her fingers or thumb during an outer cannula bending operation, as described further below.

In the example of FIGS. 32-34, tube bender 410 also includes a plurality of recesses 434, 436, 438, 439, 440, 441, 442, and 444 along its length. The recesses are separated by walls, 422, 424, 426, 427, 428, 429, and 430. The recesses facilitate manufacturing tube bender 410 by a plastic molding process and beneficially reduce the weight of tube bender 410 without unduly sacrificing its strength and rigidity.

A method of using tube bender 410 to bend outer cannula 44 and inner cannula 276, 576 during a bending operation will now be described. In accordance with one exemplary method, tissue cutting device 40 is provided and includes the same components described for the embodiment of FIGS. 1-3. However, inner cannula 276 or 576 is provided instead of inner cannula 76. In all other respects device 40 is unaltered. In accordance with another exemplary embodiment, tissue cutting device 40 of FIGS. 1-3 is used with inner cannula 76. One benefit to using inner cannula 276 or 576 is that bending portion 285, 585 has a reduced inner cannula surface area along its length relative to the same region of inner cannula 76. As a result, the potential surface area for frictional engagement between inner cannula 276, 576 and outer cannula 44 is reduced, thereby reducing the risk that inner cannula 276, 576 will seize up due to the generation of frictional heat.

In accordance with the method, outer cannula 44 of tissue cutting device 40 is inserted in outer cannula retainer lumen 20 at the proximal retainer end 416 (FIG. 34). The outer cannula 44 is advanced in the distal direction until it eventually projects into and through the recess 412 and comes into abutting engagement with stop surface 414. As shown in FIG. 35, at this point, the longitudinal axis of outer cannula 44 is substantially parallel to the longitudinal axis of tube bender distal section 413. With the tissue cutting device 40 thusly oriented, a first portion of outer cannula 44 will be disposed within outer cannula retainer lumen 420, while another portion of outer cannula 44 will be exposed, and will project away from outer cannula retainer 406 in the proximal direction. The user then moves the outer cannula 44 toward bending surface 408 until outer cannula 44 is in abutting engagement with bending surface 408 along the length of bending surface 408. As a result, the curvature of bending surface 408 is imparted to outer cannula 44 and to bending section 285 of inner cannula 276 (FIG. 36).

In certain situations, it may be desirable to adjust the distance between the distal end 47 of outer cannula 44 and the location where bending begins. In such cases, it may be helpful to provide a translucent and/or transparent outer cannula retainer 406 (or to provide a tube bender 410 that is entirely translucent and/or transparent) and to provide position indicators that reliably indicate the position of the outer cannula distal end 47 within tube bender 410. In one example, suitable reference indicators are provided along the length of outer cannula retainer 406. The reference indicators may include molded or attached ribs that are spaced apart at a predetermined distance from one another (e.g., 1 cm intervals) or other indicators such as ink markings, etchings, surface features, etc. along the length of outer cannula retainer 406.

Tube bender 410 and tissue cutting device 40 may be manipulated in a number ways during a bending operation. In one example, the thumb of one hand is placed against user engagement surface 409, and the fingers of the same hand are wrapped around tissue cutting device 40 (e.g., around the handpiece 42 or the exposed portion of outer cannula 44). Device 40 and user engagement surface 409 are then squeezed toward one another until the exposed portion of outer cannula 44 abuttingly engages bending surface 408 along its length, as shown in FIG. 36. Outer cannula 44 is then removed from outer cannula retainer 406 by sliding it in the proximal direction. In addition, the user need not keep the distal end 47 of outer cannula 44 in abutting engagement with stop surface 414 during a bending operation. Instead, outer cannula 44 may be partially withdrawn from retainer 206 prior to bending to increase the effective length of the bent portion of outer cannula 44.

As mentioned previously, tissue cutting device may be provided with a straight or pre-bent outer cannula 44. In either case, device 40 may be used to perform a tissue cutting operation in which target tissue cannot be accessed along a linear path by the surgeon. Such an operation may be performed with or without the assistance of an imaging device such as a microscope or an endoscope. A method of using tissue cutting device 40 with a curved outer cannula will now be described with reference to an open craniotomy procedure as depicted in FIGS. 37A and 37B. In accordance with the method, a portion of the patient's skull is removed to provide an access site for reaching target tissue 342. Target tissue 342 is generally inaccessible along a linear path, thus requiring a curved outer cannula for resection. Endoscope 300 is provided to visualize target tissue 342 and includes a curved shaft 306 with optical fibers 310. Endoscope cart 364 is provided and includes an articulating arm 360 with a endoscope connector 321 and an articulating joint 362. Monitor 345 allows surgeon 340 to view the target tissue 342 as endoscope 300 is manipulated. Endoscope shaft 306 preferably has a curvature that is generally similar to or the same as the curvature of outer cannula 44 since both endoscope shaft 306 and outer cannula 44 will typically follow the same path to target tissue 342. With target tissue 342 visualized, surgeon 340 then advances curved outer cannula 44 toward target tissue 342. Device 40 is then activated, causing inner cannula 276 to reciprocate along the curved path defined by outer cannula 44. Tissue received in outer cannula opening 49 is then severed by the cutting edge at distal end 279 of inner cannula 276. As with the previously described method, as inner cannula 276, 576 advances against tissue received in outer cannula opening 49, it encounters a resistive force that causes cutting section 283, 583 to pivot about hinge 280, 580 toward opening 49. The severed tissue samples are then aspirated along the curved path of inner cannula 276, 576 toward tissue collector 58. As discussed above, device 40 may also be operated as an aspiration wand without cutting tissue to manipulate target tissue 342 as necessary.

Inner cannula 276, 576 reciprocates within a curved outer cannula 44 at a reciprocate that is preferably at least about 1,000 reciprocations per minute. Reciprocation rates of at least about 1,200 reciprocations/minute are more preferred, and reciprocation rates of at least about 1,500 reciprocations/minute are even more preferred. Reciprocation rates of less than about 2,500 reciprocations/minute are preferred. Reciprocation rates of less than about 2,000 are more preferred, and reciprocation rates of less than about 1,800 reciprocations/minute are even more preferred. As with the example of FIG. 14, in a curved outer cannula device, the rates of reciprocation of device 40 allow tissue to be severed into “snippets” 112 which are relatively smaller than “slug” tissue samples obtained by many prior devices. As the reciprocation continues, a continuum of severed tissue snippets 112 is obtained.

As indicated in FIGS. 28 and 29, along bending portion 285, 585 of inner cannula 276, 576 the inner cannula lumen 278, 578 is in communication with the inner surface of outer cannula 44 because the bending portion 285. 585 is relieved. Preferably, the annular gap defined between the outer surface of inner cannula 276, 576 and the inner surface of outer cannula 44 along bending portion 285, 585 is small enough to prevent the occlusion of the annular gap with tissue samples. As mentioned previously, seal 129 (FIG. 20) beneficially prevents air artifacts, fluid (water, saline, blood, etc.) flow, and tissue sample flow in the annular clearance between inner cannula 276, 576 and outer cannula 44. This feature is particularly beneficial when the inner cannula lumen 278, 578 communicates with the inner surface of outer cannula 44 along a significant portion of the length of outer cannula 44. Thus, in addition to the benefits described previously, seal 129 also facilitates the use of a bending portion 285, 585 of inner cannula 276 which is relieved along its length.

It will be appreciated that the tissue cutting devices and methods described herein have broad applications. The foregoing embodiments were chosen and described in order to illustrate principles of the methods and apparatuses as well as some practical applications. The preceding description enables others skilled in the art to utilize methods and apparatuses in various embodiments and with various modifications as are suited to the particular use contemplated. In accordance with the provisions of the patent statutes, the principles and modes of operation of this invention have been explained and illustrated in exemplary embodiments.

It is intended that the scope of the present methods and apparatuses be defined by the following claims. However, it must be understood that this invention may be practiced otherwise than is specifically explained and illustrated without departing from its spirit or scope. It should be understood by those skilled in the art that various alternatives to the embodiments described herein may be employed in practicing the claims without departing from the spirit and scope as defined in the following claims. The scope of the invention should be determined, not with reference to the above description, but should instead be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. It is anticipated and intended that future developments will occur in the arts discussed herein, and that the disclosed systems and methods will be incorporated into such future examples. Furthermore, all terms used in the claims are intended to be given their broadest reasonable constructions and their ordinary meanings as understood by those skilled in the art unless an explicit indication to the contrary is made herein. In particular, use of the singular articles such as “a,” “the,” “said,” etc. should be read to recite one or more of the indicated elements unless a claim recites an explicit limitation to the contrary. It is intended that the following claims define the scope of the invention and that the method and apparatus within the scope of these claims and their equivalents be covered thereby. In sum, it should be understood that the invention is capable of modification and variation and is limited only by the following claims. 

What is claimed is:
 1. A tissue removal device, comprising: an outer cannula having an outer cannula lumen, a proximal end, a distal end, and an outer cannula opening adjacent the distal end, wherein the opening defines a cutting edge for severing tissue; an inner cannula disposed in the outer cannula lumen and selectively reciprocable within the outer cannula lumen, the inner cannula having an inner cannula lumen, a proximal end, an open distal end, a hinge, an elongated, continuous relieved portion whereby a portion of a side wall of the inner cannula is removed to allow for bending of the inner cannula, and a cutting edge at the distal end; wherein the relieved portion is positioned proximal to the hinge and has a length extending axially along the inner cannula that is greater than a length of the hinge, and a seal in contact with the proximal end of the outer cannula and disposed around the inner cannula; wherein the inner cannula is configured to selectively reciprocate within the outer cannula lumen between a proximal position and a distal position.
 2. The tissue removal device of claim 1, further comprising a vacuum generator in fluid communication with the inner cannula lumen, wherein the vacuum generator is selectively operable to selectively provide vacuum to the outer cannula opening.
 3. The tissue removal device of claim 2, wherein reciprocation of the inner cannula is configured to be selectively stopped proximal of the outer cannula opening and the vacuum generator is configured to apply the vacuum through the inner cannula lumen to selectively manipulate tissue without cutting tissue.
 4. A method of performing a neurosurgical procedure, comprising: providing a tissue removal device comprising: an outer cannula having an outer cannula opening adjacent the distal end, wherein there is an opening to receive tissue and fluids, an inner cannula disposed in the outer cannula and selectively reciprocable within the outer cannula, the inner cannula having a cutting edge at an open distal end to sever tissue, inserting the tissue removal device into a surgical site proximate a target tissue associated with the patient's neurological system; manipulating tissue within the surgical site so as to move the tissue from a first location or orientation to a second location or orientation within the surgical site prior to initiating a cutting operation of the tissue removal device by using the tissue removal device without resecting tissue; drawing tissue into the surgical device by applying vacuum through the inner cannula; and initiating the cutting operation of the tissue removal device after manipulating tissue to the second location or orientation by reciprocating the inner cannula between a proximal position and a distal position after manipulating tissue to the second location or orientation, such that when the inner cannula is in the proximal position, the target tissue is received in the outer cannula opening, and when the inner cannula is in the distal position, the received target tissue is severed from surrounding tissue.
 5. The method of claim 4, further comprising aspirating the surgical site prior to reciprocating the inner cannula.
 6. The method of claim 5, wherein aspirating is performed simultaneously with manipulating the tissue.
 7. The method of claim 4, wherein manipulating the tissue further comprises using the outer cannula as a blunt dissector.
 8. The method of claim 7, wherein manipulating the tissue further comprises using a portion of outer cannula to scrape selected tissue.
 9. The method of claim 8, wherein the scraping of tissue occurs before the inner cannula is reciprocated.
 10. The method of claim 8, wherein the distal opening in the outer cannula is used to scrape tissue.
 11. The method of claim 7, wherein manipulating the tissue further comprises using a portion of the outer cannula to move selected tissue.
 12. The method of claim 4, wherein manipulating the tissue further comprises using the vacuum to manipulate the tissue in the surgical site.
 13. The method of claim 12, wherein during manipulation of the tissue, the distal end of the inner cannula is positioned within the outer cannula such that the distal opening of the outer cannula is in fluid communication with the vacuum.
 14. The method of claim 13, wherein the distal end of the inner cannula is positioned proximal of the distal opening of the outer cannula.
 15. The method of claim 12, wherein the tissue is manipulated by the vacuum before the inner cannula is reciprocated.
 16. The method of claim 4, further comprising aspirating the surgical site while using the portion of the outer cannula as a vessel tamponade.
 17. The method of claim 4, wherein manipulating the tissue further comprises manipulating the tissue between reciprocation operations of the inner cannula.
 18. The method of claim 4, wherein manipulating the tissue further comprises manipulating the tissue during reciprocation operations of the inner cannula.
 19. A tissue removal device, comprising: an outer cannula having an outer cannula lumen, a proximal end, a distal end, and an outer cannula opening adjacent the distal end, wherein the opening defines a cutting edge for severing tissue; an inner cannula disposed in the outer cannula lumen and selectively reciprocable within the outer cannula lumen, the inner cannula having an inner cannula lumen, a proximal end, an open distal end, a hinge, an elongated continuous relieved portion whereby a portion of a side wall of the inner cannula is removed to allow for bending of the inner cannula, and a cutting edge at the distal end, wherein the hinge is positioned distal to the relieved portion and wherein the relieved portion has a length extending axially along the inner cannula that is greater than a length of the hinge; a seal in contact with the outer and inner cannulas; wherein the inner cannula is configured to selectively reciprocate within the outer cannula lumen between a proximal position and a distal position; and a vacuum generator in fluid communication with the inner cannula lumen, wherein the vacuum generator is selectively operable to selectively provide varying levels of vacuum to the outer cannula opening. 